The prevalence of gastroesophageal reflux disease in institutionalized intellectually disabled individuals

OBJECTIVE: The prevalence of gastroesophageal reflux disease (GERD) was ran domly investigated among Dutch and Belgian intellectually disabled individu als. METHODS: In six institutes including 1607 residents, 435 persons with IQ <5 0 underwent 24-h esophageal pH-metry and were scored for possible predispos ing factors and characteristic reflux symptoms. In 49 (11.2%) cases the tes t failed because of technical reasons. A pathological PI-I test was defined as a pH <4 for >4.5% of the measured time. Subjects with a pathological pH test (patients) were compared with those with a normal pH test (controls). RESULTS: Of the remaining individuals, 51.8% (200/386) showed a normal pH t est, whereas 186 showed a pathological pH test (median duration pH <4: 14.2 %, range: 4.5-78.4%). As possible predisposing factors scoliosis, cerebral palsy, use of anticonvulsant drugs or other benzodiazepines, and IQ <35 wer e found, whereas symptoms such as vomiting, hematemesis, rumination, and de pressive symptoms were indicative for reflux. At endoscopy reflux esophagit is was diagnosed in 129 of the 186 patients (69.4%). In 61 (47.3%) of 129 p atients, grade I, 43 (33.3%) grade II, 25 (19.4%) grade III/IV (Savary-Mill er) were found. Barrett's esophagus was found in 18 (14.0%) and peptic stri ctures in live (3.9%) cases. CONCLUSIONS: An abnormal 24-h pH-metry and symptoms suggestive for GERD wer e documented frequently in a large cohort of institutionalized intellectual ly disabled individuals. Further endoscopical evaluation confirmed the diag nosis of reflux esophagitis in the majority of these individuals. (Am J Gas troenterol 1999;94:804-810. (C) 1999 by Am. Coll. of Gastroenterology).